1. Department of Human Services Dr Paul Scown Chief Executive Melbourne Health 6 th July 2004 Melbourne Health Pilot Case Study

2. Melbourne Health is fully engaged and committed to achieving the aims of the Patient Flow Collaborative Real opportunity to built on 3 years of improvement activity Melbourne Health Approach

3. Background to Pilot Many great initiatives through HDM and HARP including the Short Stay Unit, MAPU, Day of Surgery Admissions, Resulted in reduced bypass and decreased waiting lists and hospital initiated postponements Our experience is that while this approach brings improvements, it shifts the pressure from one area to another The Health Round Table has had a similar realization

4. Currently we still have delays in…. Access to wards Access to diagnostic services Access to Theatres Access to specialist review Access to Sub acute services Working to fix problems in isolation –Results in friction between Departments and campuses –Considerable scepticism and anxiety

5. Patient Centred Care We are striving for a quality health service across the whole patient journey Past experience has shown that a “whole of service” approach is the only way to address and fix problems

6. The Melbourne Health Approach Objectives: Embrace as a Melbourne Health project – not just an RMH project Follow the patient journey across all services, including RMH, MECRS and community based Engage Divisional leadership and obtain active support at an Executive & Management level Involve and seek input from staff at all levels, across all disciplines Adopt the project methodology as an organization wide approach for ongoing improvement activities.

7. The Melbourne Health Approach Use existing structures and processes: –Patient Management Taskforce –Operational Planning Process –Incorporate program measures in Balanced Scorecard Report through Melbourne Health Executive Executive staff in coordination groups Cross section of senior clinical staff in Clinical Area teams – who were nominated and endorsed by relevant Directors and includes Executives.

8. Teams to support the work Executive Team Clinical Area Team

9. Structure Executive Team – led by Julian Maiolo, Executive Director, Operations Management Clinical Area teams led by Senior Clinical staff and supported by facilitators from the Executive Team

10. Clinical Teams Access to Sub acute & Rehabilitation Services - Stephen Davis, Director – Neurology Access to Radiology Services – Brian Tress, Director, Radiology Services Communication between Medical Units and amongst Clinicians – Peter Brennan, Executive Director, Medical Services Access to the Operating Theatre – Bruce Mann General Surgeon, specializing in trauma and oncology Bed Accessibility through Systems & Process Improvements – Gavin Becker, Divisional Director, Medicine.

11. Team Approach Diagnostics – to understand the process and problems Scope Innovations – using tools and processes that are available through the Collaborative Plan, do, study, act – implement and test improvement Spread – start in one area, then introduce to whole of organization once proven Mainstream – so that it becomes part of the culture.

12. Patient Delay Tracking Tool Pilot First innovation – to be implemented within a few weeks Web based (paper based in ED currently) Encompass all areas: Emergency, acute and subacute wards Promote ‘pull’ rather than ‘push’ system. Good means of data collection Reasons for delay can be tracked and managed Gives a view of who is waiting Allows for prioritization

13. Leadership and Communication Clear message that this project is a major priority Executive Commitment Staff involvement Board sub-committee and community involvement through the Community Advisory Committee and Safety & Service Improvement Committee Regular Updates Intranet site

14. Questions?